Palliative care matters welcome to palliative care matters. The bulletin board, document library, news, surveys and the syringe driver survey database sdsd will continue to be available at. Syringe driver drug compatibilities the eastern metropolitan palliative care consortium has produced a guide to practice on syringe driver compatibilities. Eastern metropolitan region palliative care consortium victoria clinical group syringe driver drug compatibilities guide to practice 20 july 20 these guidelines have been ed. The syringe driver drug compatibility charts, available in the palliative care formulary, summarize both the compatibility data submitted to the sdsd and that from published compatibility references. Jan 10, 2018 medications commonly used in a syringe driver. Limited evidence of compatibilitydiscuss with palliative care team. The compatibility tables contain information for a subcutaneous infusion using a cme t34 syringe pump or a nonambulatory pump containing. Mar 23, 2017 a total of 57 individuals representing 33 separate palliative care services completed the national survey.
Continuous subcutaneous infusions in palliative care. The eastern metropolitan palliative care consortium has produced a guide to practice on syringe driver compatibilities. Promoting safer use of injectable medicines by the national patient safety agency in march 2007 includes the. Your choice will be saved in a cookie on this computer. When added to a syringe driver the recommended diluent is water for injection. The bulletin board, document library, news, surveys and the syringe driver survey database sdsd will continue to be available at the site contains a link to the palliative care formulary on the medicinescomplete platform. A syringe driver is useful when the oral route of administration is not possible and repeated subcutaneous doses are. The syringe driver and the subcutaneous route in palliative care. Click here to view the syringe driver drug compatibility charts on the medicinescomplete platform.
The syringe driver is normally used to deliver medications over a 24. If administering clonazepam via a syringe pump over 24 hours csci, there is no need to use the diluent ampoule supplied in the box as the clonazepam will be administered diluted in the syringe pump. The site contains a link to the palliative care formulary on the medicinescomplete platform. Once printed, this is no longer a controlled document. If compatibility is an issue, the use of two infusion devices3 or regular or prn. The use of subcutaneous levetiracetam in palliative medicine.
The benefits and drawbacks of syringe drivers in palliative care. Syringe driver drug compatibilities guide to palliative care. Many drugs used in palliative care especially drug combinations in syringe driver are used outside of the product licence or datasheet recommendations. Subcutaneous delivery of drugs using a syringe driver is common practice within specialist palliative care units. Guidelines for clinical management and symptom control 2014 pages 150. Additional services are provided for free to members of.
Although the device itself has not been adopted universally, it has stimulated interest in the use of csci in palliative care and played a significant role in the modern history of this approach. A single drug, or more often a combination of drugs is given via a slow subcutaneous infusion to help control symptoms when other routes of administration are no longer viable, feasible or preferred. The goals of administering medicines via a syringe driver therefore need. Compatibility information from the palliative care handbook 9th edition 2019. Andrew dickman and jennifer schneider have produced a wellwritten, wellreferenced, and efficient treatment of the modern syringe driver for subcutaneous infusions as used in palliative care. A total of 57 individuals representing 33 separate palliative care services entered. Only access to the palliative care formulary is moving over to the medicinescomplete platform. Eastern metropolitan region palliative care consortium syringe driver drug. This requires the completion of a separate registration process. The eastern metropolitan region palliative care consortium emrpcc grants permission to reproduce parts of this publication for clinical and. A survey performed in 1992 reported that at least 28 drugs were used in combination with others in a single syringe driver. A syringe driver is useful when the oral route of administration is not possible and repeated subcutaneous doses are inappropriate, ineffective or impractical. Resource for health care professionals in palliative care.
Whilst the preferred route of medication administration in paediatric palliative care is the oral one, there may be occasions when this is impractical or undesirable. Syringe driver drug compatibilities practice guidelines. Syringe driver drug compatibilities practice guidelines 2011. Since the early 1980s, the syringe driver has become a commonly used technology in british palliative care, used to administer continuous subcutaneous infusions csci for symptom management. Syringe drivers are indicated when other routes become inappropriate or difficult.
Do not exceed 2g due to volume capacity in the 30ml syringe driver and monitor for site reaction and seizure activity. Concentrations compatibility is often concentration dependent. These guidelines reflect current australianvictorian palliative care practice, and published evidence. There is a clear need to identify compatibility and stability of drug. Syringe driver drug compatibilities palliative care victoria. The syringe driver and the subcutaneous route in palliative. A syringe pump also referred to as a syringe driver is used to deliver a. Continuous subcutaneous infusions in palliative care 4 ed.
If the patient is in pain, vomiting or very agitated, give a stat sc injection of. Northern england clinical networks palliative and end of. Compatibility information compatibility information is limited. Authority for administration of prescribed medication. Twycross et al 2017 the palliative care formulary 6th edition ashley et al 2014 the renal handbook 4th edition dickman et al 2016 the syringe driver 4th edition the electronic medicines compendium nice clinical guidelines relevant to each section further details available from the lead author. A syringe driver is a small portable battery operated pump that administers drugs subcutaneously by continuous infusion. The palliative care handbook guidelines for clinical management and symptom control, featuring extensive. Terms and conditions cookie and privacy policy subscription terms cookie and privacy. Therefore, it seems timely to consider their wider use. Syringe driver drug compatibilities guide to palliative care practice 2016 sodium chloride 0. This is particularly important for patients receiving palliative care, for whom a continuous infusion of medication can improve symptom control. Subcutaneous drug infusion compatibility guidelines. A single drug or a combination of drugs is given via a slow continuous subcutaneous infusion to help control symptoms when other routes of administration are no longer viable, feasible or preferred.
Do not leave drugs in a syringe driverpump for more than 24 hours. Authority for administration of prescribed medication via continuous subcutaneous infusion document no. Authors andrew dickman and jennifer schneider produced a wellwritten, wellreferenced, and efficient treatment of the modern syringe driver for subcutaneous infusions as used in palliative care. Subcutaneous levetiracetam keppra in palliative and end. This article explains how to administer drugs safely using these devices. However, when the parenteral route is required, the subcutaneous route should be the first option.
The syringe driver is a simple and costeffective method of delivering a continuous subcutaneous infusion csci. When combining medications for syringe driver use, be aware there is data available from compatibility studies for only a few combinations. Caution should be used when combining drugs in syringe. A total of 57 individuals representing 33 separate palliative care services completed the national survey. Points on mixing medications adapted from palliative care matters website. The syringe driver describes how syringe drivers allow for a single or mixture of compatible medications to be delivered by syringe rather than by infusion bag.
Subcutaneous levetiracetam keppra in palliative and. Compatibility of medicines for syringe driver infusions commonly prescribed in general practice adapted from palliative care handbook 2012. Kain project officer, centre for palliative care research and education professor patsy yates acting director, centre for palliative care research and education. Palliative care matters pang guidelines, paediatric guidelines, journal articles, events, news and books m. A maximum of 3 compatible drugs in any one syringe driver pump is recommended.
If you are on a public computer, please uncheck this box. Guidelines for syringe driver management in palliative care developed by. Syringe drivers and drug compatibility chart 29 key resources twycross r, wilcock a, howard p eds 2014 palliative care formulary. Parenteral compatibilitystability sa pharmacy medicines. Please contact a pharmacist, the palliative care team tel. When and how to use a syringe driver in palliative care bpac.
A syringe driver, or pump, represents a simple and costeffective method of delivering a continuous subcutaneous infusion csci. At the time the database was locked, 1,945 combinations had been recorded 2,2 samples were collected, but 186 were excluded due to erroneous entry, with 278 discrete combinations of drugs being identified. Syringe driver drug compatibilities guide to practice 20. A maximum of 3 compatible drugs in any one syringe driverpump is recommended. Many hospices have a helpline staffed by medical professionals. Morphine, diamorphine and oxycodone combinations in. Compatibility of drugs for use in syringe drivers for 24 hours. Specialist palliative care involvement is essential. The use of alfentanil in a syringe driver in palliative medicine.
The use of a subcutaneous or intravenous infusion using a syringe driver to deliver medications has certain advantages. Some acute areas will use nonambulatory pumps, for example alaris pump. Check the infusion rate with the new syringe as before. Syringe driver compatibility chart hospital palliative care. A compatibility study heather kean1,3, diane rigge1, phil weir1, andrew dickman2, andrew evans3, elsie gaskell3 background the issue of patient safety alert 20. There is, however, little documented information regarding clinical practice. General principles for compatibility of medicines in a syringe pump. Mar 30, 2015 this is particularly important for patients receiving palliative care, for whom a continuous infusion of medication can improve symptom control. Guidelines for subcutaneous infusion device management in. Identification of drug combinations administered by continuous.
The responsibility for prescribing is taken by the prescriber usually a doctor. Pdf the benefits and drawbacks of syringe drivers in. Nurse maude hospice palliative care service, 15 mansfield ave, christchurch. A csci provides a safe and effective way of drug administration and can be used to maintain symptom control in patients who are no longer able to take oral medication. Preparations keppra 100 mgml concentrate for solution for infusion. Syringe drivers are small portable usually battery operated devices used in palliative care. The palliative care handbook guidelines for clinical management and symptom control, featuring extensive support for advanced dementia 9th edition 2019. If compatibility is an issue, the use of two syringe driver devices3 or. Nov 15, 2016 the syringe driver is a simple and costeffective method of delivering a continuous subcutaneous infusion csci. Importantly and distinctively, the authors combined laboratory data with clinical observations to produce both a useable and practical text. However, there is wide experience of their use in palliative care. What we know syringe drivers are small portable usually batteryoperated devices used to administer medication in palliative care.
After loading a syringe, the driver depresses the plunger at a set rate for continuous, steady delivery. In palliative care, medicines may be administered by continuous subcutaneous infusion csci at various points along a patients disease. Portable infusion pumps are used in palliative care to deliver a continuous subcutaneous infusion of medication over 24 hours. Mukoreka j, sisay i 2015 safe practice in syringe pump management. Consult a medical practitioner or palliative care specialist for support and advice regarding doses and the compatibility of medications.
Do not leave drugs in a syringe driver pump for more than 24 hours. This must always be done to safeguard against errors even if the syringe has been made to the same volume. The use of alfentanil in a syringe driver in palliative. When and how to use a syringe driver in palliative care. In palliative care clinical practice, the oral route of administration is the preferred option. What is palliative care guidelines plus this website hosts the pang palliative care guidelines developed by a collaboration of uk health organisations. Drug compatibility in subcutaneous infusions chart in. The syringe driver drug compatibility charts, available in the palliative care formulary, summarize both the compatibility data submitted to the sdsd and that. In palliative care it is hugely important to be open to, and to consider, future health problems and. Its use stimulated research into the effectiveness, safety, and compatibility of.
Authority for administration of prescribed medication document no. There will be copies of the virtual syringe driver available in the professional development unit to play with. In palliative care, when a patient can tolerate neither oral nor parenteral administration of medicationsparticularly while on. The current evidence base for the feasibility of 48hour continuous. Mixing of medications in this manner is unlicensed but is supported by practice. Initiating use of a syringe driver in a patient during palliative care may represent a significant and unwelcome milestone for the patient and their familywhanau, because syringe drivers are often required when a patient is close to death. A person with palliative care needs who has difficulties ingesting or digesting medications may receive them subcutaneously under the skin using a syringe driver. Remove the empty syringe from the driver by loosening the rubber strip and sliding back the mechanism.
If the patient is in pain, vomiting or very agitated, give a stat sc injection of appropriate medication while setting up the syringe driver. Continuous subcutaneous administration of medicines using a syringe driver often becomes necessary for the control of symptoms during palliative care. The use of subcutaneous levetiracetam in palliative medicine indications for use the treatment of epileptic seizures and status epilepticus in palliative care patients who are unable to take their medications orally and when iv access is not possible or not desired. Seek advice from the specialist palliative care team if necessary. At present, current practice is to limit syringe driver infusion time to a. Dec 02, 2016 local palliative care guidelines should always be followed when mixing drugs in a syringe driver. Local palliative care guidelines should always be followed when mixing drugs in a syringe driver.
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